Is the patients with pre-hypertension are at high risk for developing frank hypertension?
Of course in this case very important to focus on lifestyle modifications to reduce the risk of later hypertension.
In Germany as in all industrial nations, there is a continued rise of average life expectancy (Links). Therefore, I would not be concerned about normal blood pressures at 130/
Do not worry so much
JNC 8 and ACCORD recommend BP target of 140/90 even in patients with DM or CKD
The SPRINT trial gave almost similar results
Defindietely lifestyle modification is indicated to retard progression and to reduce adverse cardiovascular outcome
From a prevention point of view, you should be very concerned. These persons may eventually develop hypertension and related complicatiobs if they do not receive an accurate education of lifestyle changes and future implications of borderline hypertension. In fact, I refer to it as "optional hypertension". You may also be more concerned if the patient is much younger, obese and has other risk factors for metabolic syndrome.
All the best
If you label as Pre-hypertension then it is a matter of concern just like pre-diabetes.
Intermediate analysis:
Do not worry... - 2 people
To be concerned... - 3 people
Please see JNC VII Guidelines: Management and Treatment
Not really. Kidneys are the life savers. Worry if they failing otherwise it shall be okay.
Not really. Kidneys are the life savers. Worry if they failing otherwise it shall be okay.
Not really. Kidneys are the life savers. Worry if they failing otherwise it shall be okay.
As for me very important to modify life stile.
How we can decrease BP without medications.
Approximate SBP Reduction Range:
Weight reduction - Maintain normal body weight (BMI=18.5-25) - 5-20 mmHg/10 kg weight lost
DASH eating plan - Diet rich in fruits, vegetables, low fat dairy and reduced in fat - 8-14 mmHg
Restrict sodium intake
Sodium intake till 6 gm is not that important. In india, we consume more than 11 gms daily, harfdly any one gets it. https://www.researchgate.net/publication/315726879_Is_Salt_a_Culprit_or_an_Innocent_Bystander_in_Hypertension_A_Hypothesis_Challenging_the_Ancient_Paradigm
Article Is Salt a Culprit or an Innocent Bystander in Hypertension? ...
Should I be concerned about “pre-hypertension” (120-129/80-89 mm Hg) in patients without diabetes or renal disease?
Last analysis:
Do not worry... - 3 people
To be concerned... - 3 people
Opinions divided))
Sergey:
Thanks for the excellent question and challenge, with some highly intelligent contributions posted!
Having reviewed this issue, I would add my voice that the prodominant weight of the most robust critically appraised evidentiary base supports the imperative of addressing prehypertension to avoid adverse cardiovascular outcomes. Here's why, in brief:
**
THE EVIDENCE TO DATE:
THE CRITICAL NEED OF REMEDIATING PREHYPERTENSION
A meta-analysis of 25 RCTs [Thompson 2011], of 64,162 participants, demonstrated that patients with prehypertension who received antihypertensive medications had a significant reduction in the incidence of stroke, cardiovascular events (myocardial infarction and heart failure) and mortality compared with controls. And the recent meta-analysis of prehypertension and CKD [Li 2016] demonstrated meaningful evidence showing the increased risk of chronic kidney disease with elevations in blood pressure, with the RR of developing CKD being 1.28 times higher in patients with prehypertension than in individuals with normal blood pressure, thus supporting the significance of “prehypertension” for those individuals with BP values of 120-139/80-90 mmHg. These findings are cross-confirmed by a meta-analysis that included 1,003,793 participants from 6 cohort studies and concluded that the pooled RR of end-stage renal disease (ESRD) was 1.59 in prehypertensive subjects compared with those who had optimal BP values, after adjusting for age, sex, and ethnicity [Huang 2014].
In addition, two large clinical trials showed that both candesartan/Atacand (the TROPHY Trial [Julius 2006]) and ramipril/Altace (the PHARAO Trial [Luders 2008]) could reduce the incidence of hypertension by approximately 34% - 64%, and several studies regarding the clinical benefits of treating prehypertension in the US, Europe, and China, demonstrated positive outcomes including the prevention of hypertension, avoidance of target organ damage, or improvement of clinical outcomes [Fuchs 2015] including the PREVER trial [Fuchs 2011].
**
THE SIGNIFICANT LIMITATIONS OF JNC 8: HOW NOT TO DO GUIDELINES
Furthermore, I would not draw any conclusions from the omission of prehyperension in JNC 8: The JNC Panel failed to take into account data from several robust trials we have noted here in our review summary, and the Panel relied heavily - and rather disturbingly - on the JATOS Trial, which was only powered to detect an overly demanding 40% relative risk reduction in the primary end point, and VALISH Trial which manifestly had substantially fewer primary end point events than predicted), hence both not adequately powered, while at the same time ignoring in their data review, for instance the FEVER trial that clearly found a significant reduction in its primary composite end point among patients treated to below 140 mm Hg. Another study that did pre-specify a tight control goal of
Dear Constantine,
thanks a lot for thorough answer. Your answer very important because opinion of doctors and scientist divided 50/50.
You are right, unfortunately the recommendations do not always reflect the real clinical practice.
Your opinion is based on evidence-based medicine.
I think it is question to all AH society and we need big RCT to confirm benefit treatment prehypertension.
Of course it is very important to start with life stile modifications.
Thanks again!
Last independent vote:
Do not worry... - 3 people
To be concerned... - 4 people
We are waiting for your opinion!
I like this slide!
In case that we do not have main goal in achieving the target level of BP our patient have benefit...
New data concerning blood pressure. Strict approach to determining the target level of blood pressure.Article Safety vs Efficacy of Lowering Blood Pressure
If you believe in SPRINT trial which is well done study, the answer to your question is yes.
A current, continuous medical education (CME) article in the Journal of the German Medical Associa-tion specifies a target blood pressure < 140/90 mm Hg: https://www.aerzteblatt.de/int/archive/article/199598.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Metabolic Diseases
- Glucose Metabolism Disorders
- Diabetes